[Surgery of the kinking carotid artery]

Forty-three kinkings of the epiarotic vessels were observed at the Istituto di Chirurgia Generale e Cardiovascolare dell'Università di Milano from January 1st 1971 through July 31st 1992. Six subjects were admitted for a history of one or more transient ischemic attacks. In four cases surgical resection of the kinked tract of the internal carotid and end-to-end direct reconstruction was carried out, completed by carotid bifurcation endarterectomy in three, where atherosclerotic carotid disease was severe. All the reconstructions are currently patent and no neurological symptoms were recorded at follow-up; 39 cases were treated conservatively by antiplatelet therapy and controlled each six months: to date no worsening of the echocolordoppler imaging of the lesion was noted, and all these subjects remained completely asymptomatic. The authors point out that correct clinical approach to carotid kinking is a conservative one: surgical operation must be performed only in those subjects affected with cerebral ischemic attacks not justified by other diseases.